Migraine prevention options: Medications and supplements

In 2021 the American Headache society published newer guidelines to help with medication selection. They removed some of the terminology from older guidelines and added some of the new medications.

The way the American Headache Society guidelines are presented has changed over time. There has been studies in coenzyme Q10, riboflavin, magnesium, and fever few as over-the-counter vitamin and herbal approaches. There is some smaller papers on melatonin that have been published recently. But none of these over-the-counter options are in the current guidelines statements.

The prescriptions in the current guidelines range in cost from 5 dollars a month to over a 1000 dollars a month. So insurance coverage almost always plays a strong role in what you try for migraine prevention. In general I would be happy to talk to patient's about any of the medications and over-the-counter options listed in any of the U.S. or International guidelines for the last several decades.

Medications established as effective at reducing migraine frequency:

Oral medications:

• Candesartan

• Divalproex and Valproate sodium

• Metoprolol

• Propranolol

• Timolol

• Topiramate

Injectable Medications:

• Eptinezumab

• Erenumab

• Fremanezumab

• Galcanezumab

• OnabotulinumtoxinA

Menstrual migraine specific

• Frovatriptan (Short-term prevention of menstrual-related migraine; evaluated and rejected by the FDA for this indication )

Medication that probably reduce migraine frequency (less proven):

Oral medications:

Amitriptyline

Atenolol

Lisinopril

Memantine

Nadolol

Venlafaxine

Injectable Medications:

OnabotulinumtoxinA + CGRP in combination therapy